Legal Action Centerhttps://lac.org
Helping People Rebuild Their Lives with DignityFri, 09 Dec 2016 13:25:59 +0000en-UShourly1https://wordpress.org/?v=4.6.1New York Attorney General Finds ValueOptions Denied Claims for Addiction Services at Four Times the Rate of Other Services, Reaches Settlement Including $900,000 Finehttps://lac.org/new-york-attorney-general-finds-valueoptions-denied-claims-addiction-services-four-times-rate-services-reaches-settlement-including-900000-fine/
https://lac.org/new-york-attorney-general-finds-valueoptions-denied-claims-addiction-services-four-times-rate-services-reaches-settlement-including-900000-fine/#respondSat, 19 Nov 2016 11:09:45 +0000http://lac.org/?p=2769March 5, 2015 – New York Attorney General Eric T. Schneiderman today announced a settlement with Beacon Health Options (formerly known as ValueOptions) for wrongly denying addiction and mental health benefits to millions of New Yorkers in violation of state and federal parity laws. The settlement requires ValueOptions—which administers behavioral health benefits to 2.7 million New Yorkers and 45 million Americans—to overhaul its claims review process and pay a $900,000 penalty. The settlement against ValueOptions is the fourth reached by AG Schneiderman’s Health Care Bureau since last year, making AG Schneiderman’s office a national leader in enforcing the federal parity law.

]]>March 5, 2015 – New York Attorney General Eric T. Schneiderman today announced a settlement with Beacon Health Options (formerly known as ValueOptions) for wrongly denying addiction and mental health benefits to millions of New Yorkers in violation of state and federal parity laws. The settlement requires ValueOptions—which administers behavioral health benefits to 2.7 million New Yorkers and 45 million Americans—to overhaul its claims review process and pay a $900,000 penalty. The settlement against ValueOptions is the fourth reached by AG Schneiderman’s Health Care Bureau since last year, making AG Schneiderman’s office a national leader in enforcing the federal parity law. Previously, his office settled with MVP Health Care, EmblemHealth, and Cigna for parity violations. ValueOptions administered behavioral health benefits for both MVP Health Care and EmblemHealth.

The Attorney General’s Health Care Bureau’s investigation found that ValueOptions denied mental health claims twice as often as other medical and surgical claims, and it denied addiction claims four times as often as other medical and surgical claims. ValueOptions violated state and federal parity laws that require insurers that provide mental health and substance use disorder benefits to provide them equally—or at parity—with other medical and surgical benefits. In its press release, the Attorney General noted that, although one in ten New Yorkers has a substance use disorder, only 11% of those individuals receive any treatment. Research has shown that the primary reason that people who seek substance use disorder treatment do not receive it is a lack of insurance coverage and inability to pay the cost.

The Legal Action Center worked successfully with the substance use disorder and mental health fields towards passage of the federal mental health and addiction parity law in 2008. Furthermore, through our work co-leading the national Coalition for Whole Health, we have been instrumental in securing strong federal rules for covering substance use disorder and mental health treatment at parity with other health benefits in order to ensure that the law is implemented effectively.

For more details about the agreement between the Attorney General and Beacon Health Care/ ValueOptions, see the Attorney General’s press release. For more information about the AG’s previous settlements, the Legal Action Center’s summaries of the EmblemHealth settlement and the MVP Health Care settlement provide additional detail. For additional information about the federal mental health and addiction parity law, see the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA)’s website, as well as the Legal Action Center’s Frequently Asked Questions and the tools developed by the Coalition for Whole Health. New Yorkers with questions or concerns about the settlement, the mental health and addiction parity laws, or any other health care matters can also call the New York Attorney General’s Health Care Bureau Helpline at 1-800-428-9071.

Please act now. Submit comments on New York’s request for a federal waiver to Medicaid rules barring the use of Medicaid for incarcerated individuals.

New York is seeking federal approval to become the first state in the nation to use Medicaid to pay for certain services that would help individuals transition from incarceration back to the community.

Incarcerated individuals would be connected to treatment, medication support and intensive care coordination prior to release, instituting a continuum of care and thereby improving their health.

Using Medicaid to help people as they leave jails and prison would be a huge step in transforming the criminal justice system from a punishment to a treatment-focused model.

Disruptions in medical care upon reentry lead to poor and costly health outcomes, such as increased drug use and re-incarceration, including a 12-fold rise in the risk of death in the first two weeks post-release.

Providing the needed array of transitional services would significantly increase the chances of a successful reentry into the community.

Click here for LAC’s comment template. Submissions are due this coming Sunday, November 20 at 11AM. Submit your comments here.

Please ask others to also submit comments.

ACT NOW and tell the Federal government to take this transformative step in changing in the criminal justice system and strengthening local communities.

]]>https://lac.org/act-now-seeking-comments-nys-application-medicaid-waiver/feed/0Joint Statement on Federal Mental Health and Substance Use Disorder Parity Task Force Reporthttps://lac.org/joint-statement-on-parity-task-force-report/
https://lac.org/joint-statement-on-parity-task-force-report/#respondMon, 31 Oct 2016 22:09:29 +0000https://lac.org/?p=6994The undersigned organizations issued the following statement today regarding the report released on October 27th by the Mental Health and Substance Use Disorder (MH and SUD) Parity Task Force, established by President Obama in March 2016.

]]>The undersigned organizations issued the following statement today regarding the report released on October 27th by the Mental Health and Substance Use Disorder (MH and SUD) Parity Task Force, established by President Obama in March 2016.A more in-depth analysis of the report and its recommendations is forthcoming; the below represents an initial analysis of the Parity Task Force report.

“We applaud the Obama administration and the Task Force Co-Chairs, White House Office of National Drug Control Policy Director Michael Botticelli and Director of the White House Domestic Policy Council Cecilia Muñoz, for their dedication to ensuring equal coverage of and meaningful access to mental health and substance use disorder (MH and SUD) care through strong implementation and enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA). Access to mental health care is critically important to reducing the rising suicide rate in America. In light of the nation’s opioid crisis, strong enforcement of the Parity Act is critical to ensuring better access to life-saving substance use disorder care. The report released last week bolsters work to improve access to care in important ways by, among many other recommendations and initiatives, directing $9.3 million to states to strengthen implementation of the Parity Act, providing additional technical assistance to state regulators to improve parity compliance in commercial insurance and Medicaid, and taking important initial steps to both strengthen consumer rights to detailed information about why their insurance claims are denied, and to simplify the complaint process for consumers.

However, much additional work remains to help individuals and families who need mental health and substance use disorder care realize the full promise of MHPAEA. We call on the federal government to implement not only the Task Force’s excellent recommendations, but to also undertake the following critically important actions:

Issue additional guidance detailing what constitutes adequate disclosure. The next administration should address this problematic area by immediately releasing guidance that models, for issuers, appropriate disclosure of coverage and plan design information, as well as complete and specific disclosure of the factors, evidentiary standards that define such factors, processes and strategies for development and application of non-quantitative treatment limitations, both as written and as applied in operation.

Require prospective parity compliance reviews. We urge the federal government to shift the burden of Parity Act enforcement away from consumers and their family members and instead require carriers to demonstrate compliance on the front end, as required by the law. We urge the next administration to rely less on “back-end” enforcement and consumer complaints by requiring carriers to demonstrate (beyond a simple “attestation of compliance”) that their MH/SUD benefits comply with the law before health insurance products are determined eligible for sale.

Streamline the consumer complaint and appeals process. We appreciate the release of the beta version of the Consumer Web Portal and urge the federal government to direct sufficient resources toward further developing this tool so consumers and family members can efficiently and effectively navigate the process and assert their parity rights.

Issue guidance identifying plan standards that violate the law. We appreciate that the new guidance accompanying the report reiterates that it is a violation of the law for insurers to impose stricter prior authorization and fail-first policies on SUD and MH benefits, including medication-assisted treatment (MAT). However, more explicit guidance detailing plan policies and practices that violate the law are needed. For example, the federal government should make clear that blanket coverage exclusions of methadone-maintenance therapy or any other medication or service violate the law. Despite clear evidence of effectiveness, MAT remains a tragically under-utilized tool in helping people enter and sustain recovery.

We applaud the release of this report as an important step forward in realizing the intent of the Parity Act and thank President Obama for his continued leadership in working to improve coverage for and access to mental health and substance use disorder care. We, the undersigned organizations, are prepared and committed to working closely with the federal government and state policymakers and regulators to achieve the full promise of the law.”

Addiction Policy Forum
American Academy of Addiction Psychiatry
American Association on Health and Disability
American Association for the Treatment of Opioid Dependence
The American Foundation for Suicide Prevention
American Group Psychotherapy Association
The American Psychological Association Practice Organization
American Society of Addiction Medicine
Association for Ambulatory Behavioral Healthcare
California Consortium of Addiction Programs & Professionals
Clinical Social Work Association
Community Catalyst
Depression and Bipolar Support Alliance
Faces and Voices of Recovery
Harm Reduction Coalition
Health Equity Leadership and Exchange Network (HELEN)
Health Law Advocates
Kennedy Center for Mental Health Policy and Research at the Morehouse School of Medicine
The Kennedy Forum
The Kennedy Forum Illinois
Lakeshore Foundation
Legal Action Center
The Margaret Clark Morgan Foundation
Mental Health America
Minnesota Recovery Connection
Morehouse School of Medicine
NAADAC – The Association for Addiction Professionals
NAMI – National Alliance on Mental Illness
NAMI Chicago
National Association of Addiction Treatment Providers
National Association for Children of Alcoholics (NACoA)
National Association of County Behavioral Health and Developmental Disability Directors (NACBHDD)
The National Association of Psychiatric Health Systems
National Association for Rural Mental Health (NARMH)
The National Center on Addiction and Substance Abuse
National Council for Behavioral Health
NCADD-MD
No Health without Mental Health
The Parity Implementation Coalition
ParityTrack
Partnership for Drug-Free Kids
Representative Patrick J. Kennedy
Satcher Health Leadership Institute at Morehouse School of Medicine
Shatterproof
The Thomas Scattergood Behavioral Health Foundation
Thresholds (Illinois)
Treatment Communities of America
Treatment Research Institute

https://lac.org/joint-statement-on-parity-task-force-report/feed/0LAC’s Letter to the Washington Post Editor in Support of Insurance Coverage for MAThttps://lac.org/lacs-letter-washington-post-editor-support-insurance-coverage-mat/
https://lac.org/lacs-letter-washington-post-editor-support-insurance-coverage-mat/#respondFri, 21 Oct 2016 15:28:26 +0000https://lac.org/?p=6980LAC Vice President for Health Initiatives Ellen Weber responds to an article in the Washington Post entitled "The Drug Industry’s Answer to Opioid Addiction: More Pills" with a letter to the editor.

The Oct. 16 front-page article “An industry’s answer to deadly opioid addiction: More pills” did not address an even bigger question: Why will insurance companies pay for medications to treat the side effects of opioid use disorders — and the opioids themselves — but not the medications that treat people who become addicted?

Treatment that uses three Food and Drug Administration-approved medications — methadone, buprenorphine and naltrexone — is effective, helping hundreds of thousands of people recover from opioid use disorders. Yet many insurance plans sold on state insurance exchanges and offered by employers don’t cover such treatment.

I have counseled many individuals with opioid use disorders who purchased insurance for the primary purpose of covering their medication-assisted treatment, only to learn that their plan didn’t pay for it or created significant barriers to obtaining it.

The federal Mental Health Parity and Addiction Equity Act, which was signed into law in 2008, was designed to render this insurance exclusion unlawful. Robust enforcement of the Parity Act would save precious lives and billions of dollars spent on the tragic consequences of untreated addiction.

Ellen M. Weber

Ellen Weber is the Vice President for Health Initiatives, Legal Action Center, and Professor of Law, University of Maryland Carey School of Law

]]>https://lac.org/lacs-letter-washington-post-editor-support-insurance-coverage-mat/feed/0Sign on to the Coalition for Whole Health’s Comments to the President’s Mental Health and Addiction Parity Task Forcehttps://lac.org/sign-on-to-the-coalition-for-whole-healths-comments-to-the-presidents-mental-health-and-addiction-parity-task-force/
https://lac.org/sign-on-to-the-coalition-for-whole-healths-comments-to-the-presidents-mental-health-and-addiction-parity-task-force/#respondThu, 11 Aug 2016 22:34:50 +0000http://lac.org/?p=6751The Coalition for Whole Health, a national coalition of organizations working to improve coverage for and access to MH and SUD care, drafted comments to the Parity Task Force that recommend additional guidance on and enforcement of the federal MH/SUD parity law by States and the federal government.

]]>In March, President Obama issued a Presidential Memorandum establishing a Mental Health and Substance Use Disorder (MH and SUD) Parity Task Force. In 2008, the federal Mental Health Parity and Addiction Equity Act (MHPAEA) became law. Although the federal MH/SUD parity law seeks to prohibit discrimination in health insurance coverage of mental health and substance use disorder benefits, people seeking MH and SUD services and medications continue to experience many challenges in accessing care.

The President’s Parity Task Force is seeking comment from patients, families, consumer advocates, health care providers, insurers, and other stakeholders on their experience with mental health and substance use disorder parity requirements.

The Coalition for Whole Health (CWH), a national coalition of organizations working to improve coverage for and access to MH and SUD care, drafted comments to the Parity Task Force that recommend additional guidance on and enforcement of the federal MH/SUD parity law by States and the federal government. To sign your organization on to the Coalition’s comments, please go to: https://www.surveymonkey.com/r/H56BJLK and enter your information by COB August 26th.

In addition, please feel free to use the Coalition’s comments as a template for your organization’s own comments. Comments can be emailed to: parity@hhs.gov or can be submitted through the comment form on the Task Force website: www.hhs.gov/parity. The deadline for submission is August 31st.

Please contact Gabrielle at gdelagueronniere@lac-dc.org with any questions. Thank you for all of your work to improve access to addiction and mental health care!

]]>Legal Action Center (LAC) applauds the recent announcement by New York Governor Andrew M. Cuomo that his administration has issued guidance to insurers regarding their legal obligations to provide mental health and substance use disorders coverage at parity with medical or surgical care.

LAC President Paul N. Samuels issued the following statement in response to the announcement:

“We are thrilled to see the Cuomo administration take such a bold, leadership position when it comes to coverage for mental health and substance use disorders. By staking out a ‘zero tolerance’ policy for insurance companies that fail to provide legally mandated coverage, the Governor is making it clear that access to care is a priority. This action keeps New York as a leader in the nation when it comes to parity enforcement. Much work remains to be done to ensure the promise of this policy is fully realized, and we look forward to working with the Governor and leaders in the state to ensure more people are able to receive mental health and addiction treatment services.”

For more information on LAC’s work to support enforcement of New York and federal parity requirements, please visit LAC’s parity resources.

]]>https://lac.org/governor-cuomo-issues-zero-tolerance-policy-for-insurers-that-fail-to-provide-equal-substance-use-coverage/feed/0United Hospital Fund Awards LAC $60,000 to Create Report on Model Health Policies in the Criminal Justice Systemhttps://lac.org/united-hospital-fund-awards-lac-60000-to-create-report-on-model-health-policies-in-the-criminal-justice-system/
https://lac.org/united-hospital-fund-awards-lac-60000-to-create-report-on-model-health-policies-in-the-criminal-justice-system/#respondFri, 08 Jul 2016 20:02:49 +0000http://lac.org/?p=6610The United Hospital Fund has awarded a $60,000 grant to the Legal Action Center to publish a guide to policies and practices that best engage and retain individuals involved in the criminal justice system in effective health care.

]]>July 15, 2016—The United Hospital Fund has awarded a $60,000 grant to the Legal Action Center (LAC) to produce two issue briefs on policies and practices that best engage and retain individuals involved in the criminal justice system in effective health care. The first brief will examine New York’s progress in providing Medicaid coverage to incarcerated individuals, and the second brief will analyze progress and issues around linkage to evidence-based health care services upon individuals’ reentry into the community.

People in the criminal justice system are seven times as likely as the general population to experience mental illness, substance use disorders, infectious disease, and chronic health conditions. Following release from prisons or jails, they experience disruptions in medical care and treatment that contribute to higher drug use rates, re-incarceration, and poor health outcomes, including a 12-fold increase in the risk of death in the first two weeks post-release. At every stage of the criminal justice system, lack of treatment can lead to higher recidivism rates, increased long-term costs, and permanent harm to individuals, families and communities.

According to Paul N. Samuels, Director and President of LAC, the briefs will help shape a guide that will be the first of its kind. It will draw on LAC’s experience working with New York State agencies to enroll justice-involved individuals in Medicaid and connect them to coordinated care. Since LAC began working on this initiative in 2013, over 11,000 individuals in New York’s criminal justice system have been enrolled in Medicaid. An estimated 400 people leaving state prisons are now gaining Medicaid coverage each month, and over 2,000 individuals in the criminal justice system have been linked to Health Homes. The state has also budgeted $6 million to pay for Medicaid enrollers and preliminary care coordination inside prisons.

United Hospital Fund’s generous grant will allow LAC to detail New York State’s experience and make recommendations for further project progress and replication. LAC Policy Director Sebastian Solomon states, “We are committed to securing access to effective healthcare for individuals at all stages of the criminal justice system. With UHF support, we will be able to disseminate information that will help ensure people have access to care from pre-arrest to post-incarceration.”

Informed by LAC’s more than 40 years of experience working at the intersection of the health and criminal justice systems, the guide will play a crucial role in transforming the focus of the criminal justice system from punishment to treatment for the large percentage of individuals whose incarceration is inextricably linked to chronic health conditions such as substance use and mental health issues.

“Ultimately, by sharing LAC’s expertise, we aim to improve countless lives and public safety,” said Samuels. “Our experience in connecting justice-involved individuals in New York State to the health care they need and deserve has given us great insight. We hope our report provides a model for transforming the criminal justice and health care systems nationwide.”

About the Legal Action Center
The Legal Action Center is the only non-profit law and policy organization in the United States whose sole mission is to fight discrimination against people with histories of addiction, HIV/AIDS, or criminal records, and to advocate for sound public policies in these areas.

About The United Hospital Fund
United Hospital Fund works to build a more effective health care system for every New Yorker. An independent, nonprofit organization, UHF analyzes public policy to inform decision-makers, finds common ground among diverse stakeholders, and develops and supports innovative programs that improve the quality, accessibility, affordability, and experience of patient care.

My health insurer will only approve 2 days of residential addiction treatment at a time. What can I do?

My health insurer’s network has no doctors who prescribe Suboxone. What are my rights?

My health insurer says my psychologist visits are not medically necessary. Is there anything I can do?

A federal law forbids health insurers from discriminating against people with substance use or mental disorders. Health Insurance for Addiction & Mental Health Care: A Guide to the Federal Parity Law explains patients’ and providers’ rights care under this law, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, or “federal parity law.” The Guide also briefly explains some relevant New York State laws. Although written for a New York audience, much of the Guide can be used anywhere in the country.

]]>https://lac.org/parity-guide-explains-right-to-health-insurance-coverage-for-addiction-mental-health-care/feed/0Ellen Weber to Rejoin LAC on July 5th as Vice President for Health Initiativeshttps://lac.org/ellen-weber-to-rejoin-lac-on-july-5th-as-vice-president-for-health-initiatives/
https://lac.org/ellen-weber-to-rejoin-lac-on-july-5th-as-vice-president-for-health-initiatives/#respondTue, 28 Jun 2016 21:20:34 +0000http://lac.org/?p=6503LAC is delighted to announce that Ellen Weber will be rejoining the Center on July 5th as our Vice President for Health Initiatives. Ellen, who worked at the Legal Action Center in both New York and Washington, D.C. from 1985 to 2002, including establishing our D.C. office in 1988, will return to lead the Center’s health care initiatives.

]]>June 28, 2016 – Washington D.C. – The Legal Action Center is delighted to announce that Ellen Weber will be rejoining the Center on July 5th as our Vice President for Health Initiatives. Ellen, who worked at the Legal Action Center in both New York and Washington, D.C. from 1985 to 2002, including establishing our D.C. office in 1988, will return to lead the Center’s health care initiatives.

A national expert on laws and policies concerning substance use disorder for three decades, Ellen’s work will focus on the enforcement of the Mental Health Parity and Addiction Equity Act, national health care policy development and state-based health insurance support. Ellen has been on the faculty of the University of Maryland Carey School of Law since 2002, directing the Drug Policy and Public Health Strategies Clinic, which is part of the Law School’s nationally ranked Health Law and Clinical Law programs.

Most recently, Ellen and her clinic students have worked with community partners on the implementation of the Affordable Care Act and the Parity Act in Maryland, integration of the financing and delivery of publicly-funded substance use disorder and mental health services, and harm reduction strategies to address Maryland’s opioid use epidemic. Ellen will continue to work on Maryland-based health care policy initiatives over the next year, through the support of the Open Society Institute-Baltimore, as a part-time Carey Law School faculty member.

]]>https://lac.org/ellen-weber-to-rejoin-lac-on-july-5th-as-vice-president-for-health-initiatives/feed/0LAC Policy Director Gabrielle de la Guéronnière Receives NASADAD Awardhttps://lac.org/lac-policy-director-gabrielle-de-la-gueronniere-receives-nasadad-award/
https://lac.org/lac-policy-director-gabrielle-de-la-gueronniere-receives-nasadad-award/#respondThu, 16 Jun 2016 16:52:58 +0000http://lac.org/?p=6488The Legal Action Center is delighted to congratulate our Director of Policy, Gabrielle de la Guéronnière, on receiving the Service Award for Outstanding Service and Commitment to the Field of Substance Abuse Treatment from the National Association of State Alcohol and Drug Abuse Directors (NASADAD) at their 2016 Annual Conference this June in Salt Lake City, UT.

]]>The Legal Action Center is delighted to congratulate our Director of Policy, Gabrielle de la Guéronnière, on receiving the Service Award for Outstanding Service and Commitment to the Field of Substance Abuse Treatment from the National Association of State Alcohol and Drug Abuse Directors (NASADAD) at their 2016 Annual Conference this June in Salt Lake City, UT.

Legal Action Center Director/President Paul N. Samuels said, “All of us at the Legal Action Center are beyond proud of Gab. For over 13 years, she has been an integral part of the LAC team devoted to working on improving health responses to addiction and combating discrimination of those with histories of addiction, HIV/AIDS, or criminal records. Her leadership, dedication, and knowledge have earned us many national policy victories and helped countless lives across our country.”

Gabrielle’s scope of work includes working to ensuring that the federal health care reform and parity laws are implemented well for people with addiction and mental health service needs, and for people in the criminal justice system; and eliminating legal and policy barriers faced by people with criminal records and drug addiction histories. She successfully directed the Center’s federal advocacy of the Second Chance Act reentry legislation as well as inclusion of strong addiction and mental health provisions in the Affordable Care Act. She also coordinates and helps to direct strategy for the Coalition for Whole Health, a group of national addiction and mental health organizations, and is a frequent national presenter on health and criminal justice policy.

Gabrielle is so appreciative of this recognition from NASADAD. “It’s a great honor to receive this award from the National Association of State Alcohol and Drug Abuse Directors. I am very proud of the work we all do at the Legal Action Center to fulfill our mission of helping fellow Americans rebuild their lives with dignity. This is work I am extremely passionate about, and work that all of us at LAC believe is critical to the progress of our country. To be recognized for this is really special, and I am incredibly thankful.”

Originally incorporated in 1971, NASADAD has fostered the development of effective alcohol and other drug abuse prevention and treatment programs throughout the country. The Legal Action Center thanks NASADAD for their crucial work and for recognizing Gabrielle as a leader in the field.